Difficulty with intercourse after radical vulvectomy

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Dear OncoLink "Ask The Experts," I had a radical vulvectomy 1 year ago. I am very grateful to be cancer free but intercourse is difficult and painful. Should we keep trying?

Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:

There are many reasons why penetration may be difficult after this type of surgery. If vaginal dryness is a problem, I would recommend using a generous amount of water based lubricant such as KY Jelly or Astroglide. If the problem is due to a very small vaginal opening, sometimes diligent use of vaginal dilators can be of use.

I would recommend that you discuss your concerns with your gynecologic oncologist. He or she should be experienced in dealing with these issues and may prescribe a set of dilators that you can use. These dilators start small in diameter, and can be inserted gently every day or several times a week to help stretch the vaginal opening. Gradually over time, larger diameter dilators may be used until a sufficient amount of stretching is achieved to permit more comfortable intercourse. Particularly you have had radiation therapy to the vulvar area, regular use of these dilators may be required for many years to help maintain the size of the vaginal opening.

Mar 3, 2015 - In patients with groin node-positive vulvar cancer who have undergone radical vulvectomy and inguinal lymphadenectomy, postoperative radiation is associated with a significantly lower rate of cancer-related death than postoperative pelvic node resection, according to a study in the September issue of Obstetrics & Gynecology.